背景:第二产程延长会增加严重会阴裂伤的风险,产后出血,手术交付,可怜的阿普加得分。无效的第二阶段更长。产妇在第二产程中的推挤是由子宫收缩产生的非自愿排挤力的重要原因。初步数据表明,活跃的第二阶段的视觉生物反馈会加速出生。
目的:本研究的目的是评估与对照组相比,会阴的视觉反馈是否缩短了第二产程的时间。
方法:一项随机对照试验于2021年12月至2022年8月在马来亚大学医学中心进行。未产妇女即将开始活跃的第二阶段,在学期,单例妊娠,确保胎儿状态和阴道分娩无禁忌症的研究被随机分配到实时观察产妇的内视(干预)或产妇面部(假手术/安慰剂对照),作为其推进过程中的视觉生物反馈.使用了连接到平板电脑显示屏的蓝牙摄像机:在干预臂中,摄像机聚焦在内视和控制臂上,在母亲的脸上。参与者被指示在他们的推动期间观看显示屏。主要结果是使用0-10视觉数字评定量表评估对分娩间隔和产妇对推动经验的满意度的干预。次要结果包括分娩方式,会阴损伤,分娩失血,出生体重,出生时脐带动脉血酸碱度和过量,1分钟和5分钟时的Apgar评分和新生儿入院。数据分析采用t检验,Mann-WhitneyU测试,卡方检验和Fisher精确检验视情况而定。
结果:230名女性被随机分配(115名干预组和115名对照组)。活动第二阶段持续时间(干预至分娩间隔)中位数[四分位数间距]16[11-23]与17[12-31]分钟p=0.289,干预和控制臂的产妇对推动经验的满意度分别为9[8-10]和7[6-7]P<0.001。随机分配到干预组的女性更有可能同意向朋友推荐他们的管理:88/115(76.5%)与39/115(33.9%)RR2.26(95CI1.72-2.97),p<0.001更有可能维持较不严重的会阴损伤模式(p=0.018)。
结论:在推送过程中作为视觉生物反馈实时观察产妇内省,与观察产妇面部的假对照相比,产妇满意度更高,但分娩时间并未显着缩短。
A prolonged second stage of labor increases the risk of severe perineal laceration, postpartum hemorrhage, operative delivery, and poor Apgar score. The second stage is longer in nulliparas. Maternal pushing during the second stage of labor is an important contributor to the involuntary expulsive force developed by uterine contraction to deliver the fetus. Preliminary data indicate that visual biofeedback during the active second stage hastens birth.
This
study aimed to evaluate if visual feedback focusing on the perineum reduced the length of the active second stage of labor in comparison with the control.
A randomized controlled
trial was conducted in the University Malaya Medical Centre from December 2021 to August 2022. Nulliparous women about to commence the active second stage, at term, with singleton gestation, reassuring fetal status, and no contraindication for vaginal delivery were randomized to live viewing of the maternal introitus (intervention) or maternal face (sham/placebo control) as visual biofeedback during their pushing. A video camera Bluetooth-linked to a tablet computer display screen was used; in the intervention arm, the camera was focused on the introitus, and in the control arm, on the maternal face. Participants were instructed to watch the display screen during their pushing. The primary outcomes were the intervention-to-delivery interval and maternal satisfaction with the pushing experience assessed using a 0-to-10 visual numerical rating scale. Secondary outcomes included mode of delivery, perineal injury, delivery blood loss, birthweight, umbilical cord arterial blood pH and base excess at birth, Apgar score at 1 and 5 minutes, and neonatal intensive care unit admission. Data were analyzed with the t test, Mann-Whitney U test, chi-square test, and Fisher exact test, as appropriate.
A total of 230 women were randomized (115 to intervention and 115 to control arm). The active second stage duration (intervention-to-delivery interval) was a median (interquartile range) of 16 (11-23) and 17 (12-31) minutes (P=.289), and maternal satisfaction with the pushing experience was 9 (8-10) and 7 (6-7) (P<.001) for the intervention and control arm, respectively. Women randomized to the intervention arm were more likely to agree to recommend their management to a friend (88/115 [76.5%] vs 39/115 [33.9%]; relative risk, 2.26 [95% confidence interval, 1.72-2.97]; P<.001) and more likely to have less severe perineal injury (P=.018).
Real-time viewing of the maternal introitus as visual biofeedback during pushing resulted in higher maternal satisfaction compared with the sham control of viewing the maternal face; however, the time to delivery was not significantly shortened.